Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | 77 | OK |
N | 222Z00000X | Podiatrist | 77 | OK |
Y | 224P00000X | Prosthetist | 125 | OK |
NPI | 1013502509 |
---|---|
Provider Name | Amanda Beth Knowles |
First Address | Oklahoma City, OK 73104-4637 |
Second Address | Oklahoma City, OK 73104-4637 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/03/2021 |
Last Update Date | 19/11/2021 |